I have the greatest privilege of being associated with Native cultures of many continents.. thus satisfying my curiosity and desire to travel and the chance to help them with my medical expertise. these notes are from those travels. I am a professor at the University of Havana

mardi 25 juillet 2017

WHEN
IT COMES TO CUSTOMER SERVICE ON THE GROUND, NO ONE CAN BEAT THE UNITED STATES
SERVICE INDUSTRY.

I
had arrived in the United States from Qatar on the 16th July and my
destination was the American Indian Reservations in the Plains States. I flew
to Miami, as I consider this to be my American Base, so that I can gather my
balance and move on to the Midwest.

The
flight on the 17th was unremarkable. I had a very pleasant stay at
the Centurion Club at Concourse D, including a head and neck massage by Vicky
who is good at what she does.I had been
upgraded on the flight from Miami to Dallas and after a very short stay at the
Admirals Club; I boarded the regional airlines flight, upgraded on that one as
well, with only about 9 first class seats. I was busy reading and writing and
planning my upcoming trips and the short flight glided by smoothly. On arrival
at Omaha Airport, a very small airport with no international or long distance
flights (New York, Dallas, Houston, Charlotte, Minneapolis, Phoenix, Denver. so
this is an outlying station connecting to the hubs).

I
had no special identifications on the iPhone 7 plus except two flags:
Australia, Breizh (Brittany) and the face of Emir of Qatar, to show my
solidarity with Qatar in the current crisis.

I
tried not to let the panic take over when I realized that I had left the
telephone in the men’s toilette near the exist from the American Airlines
arrival area. Alas, within five minutes, the phone had vanished. I went to the
information desk, lost and found and custodian’s office and the airport police.
No one had turned in an iPhone.

My
iPhone had been a gift to me from one of the Indian tribes, so that I can be
available to them, regardless of where I was in the world and it had been a
good tool for me, to travel around the world and be in touch with my Tribal
colleagues.

The
sim card in it was from T-Mobile, as a part of family plan of my Brother In Law
and he quickly called the T mobile and cancelled the sim card. Using the Find
my phone app, we reported it as lost and left a message to contact if it were
found. But when you opened the app, iPhone appeared as OFFLINE.

Brandy,
my friend at AVIS was rather more philosophical. It takes a little time for
lost things to find their way to Lost and Found and also most people do not
know where to return the lost items. Everybody especially the employees of AVIS
rent a car were being more than helpful.

But
I was left with a sense of guilt, why did I leave the telephone in the
Bathroom? Why didn’t I put the phone in a safe place if I were using it in the bathroom?
I was using whatsapp to tell a friend in Iran that I had arrived

Just
arrived in Omaha 14 48

I
received her reply 1456

I
left with somewhat of a heavy heart, wanted to drive the 150 km to the Indian
reservation, feeling bad that I had lost the phone the tribe had loaned to me.

Every
one was comforting, my colleague and her husband did some tracking and IT
manager of the tribe wrote to say, comfortingly, that telephones are lost
constantly, and he would replace it for me.

Once
I was back with the Indians, my mood began to change. The chaos and
inevitability and the risk which are commonplace among the Indians of North America,
was soothing, as I fit into the cosmos and worldview and the fact that the next
ten days of my stay in the USA, I would be surrounded by them, not by
descendants of recent arrivals to this land they call the Turtle Island.

Every
day I would call the Lost and Found at the airport and they would say: strange,
normally we get one or two iPhones per day but for the last few days we have
not received any. Police refused to take a report as I had lost the phone and
not robbed of it.

In
the meantime T mobile had offered to send me a new sim card with the same
telephone number to an address in this isolated village. My brother had to pay
a nominal fee for the UPS services. T mobile response was swift and within 30
hours of contacting them, I had a new sim card with the same old number.

I
had lost the telephone around 3 pm on Monday, within 48 hours I had the
replacement sim card mailed to me, so that I got back my number, despite it
having to be used on another telephone but at least there was a method for anyone
to get in touch with me.

On
Thursday, around noon, a message had been left on my number (in the replaced
telephone), It was from the American Airlines and they said, they have found my
phone and that could I please call a particular number to confirm. It was late
in the evening when I saw the message so on Friday I called them and sure
enough I could identify my phone, two flags and a face.

Someone
recognized Sheikh Tamim of Qatar or someone associated that face with me, or
how did the phone end up in the lost and found section of the American Airlines
at the airport?

I
often fly in and out of that airport, about once a month, so there are people
who work there who see me twice a month, but there are thousands of people
wandering through the airport. I am very friendly to the people at the airport:
AVIS rent a car people, the agents who check me in at the counter or at the
gate and very often I have a little conversation with them, many of them
showing interest in my far away destination. It is possible that someone from
the Airline, soon after its arrival, found the phone and then looked at the
passenger list, and matched my name and looking up my profile could find my
telephone number. In any case, somebody had to put some work into that, and I am
grateful for him or her.

Throughout
the drive to the airport, I was thinking: why did this happen to me? I tried to
think in the worldview of the American Indians, they would say, you had done something
that is why this happened. What would that Something be? That I had behaved in
an arrogant or not so humble fashion during this past trip through the Orient
and the Levant. I had to agree; I had become too engrossed in the comforts of
flying Qatar Airways that I might have forgotten certain niceties that I
normally exchange with fellow travellers. I had to ask forgiveness for that,
believe it or not on the Thursday, before I received the confirmatory message
that they had found my phone, I had discussed with some good friends about
humility and expressed my gratitude for their friendship.

Everything
is connected, say the Indians. A lovely South Korean woman was my FA on the Doha
to New York portion, and when I arrived at the Indian reservation, a gaggle of
nursing students from South Korea were there to listen to the interpretation of
Indian culture.

I
had apologized for my lack of humility, soon after that my phone was returned.

The
lady who called me, addressed me by my first name, and said your phone has been
found. I had not lodged a complaint with the American Airlines and they had
done some groundwork to connect that phone to my name on the passenger list.

Every
thing is related, say the Indians, and I do believe in that.

Despite
the national hysteria of the politics and health care in the USA at the moment,
I felt very grateful for the people of USA, their civic responsibility and also
the generousness of their spirit.

I
am grateful to them.

(below is a typical sunset seen at this Indian Reservation at this time of the Year)

vendredi 21 juillet 2017

Most
people suffer from Illnesses and the medical profession objectifies those
symptoms elicited and then gives it a name, and it becomes a Disease. During
this objectification, the social, the cultural, the societal, the
psychological, the economical aspects of the symptoms are forgotten.

Thus
the patient leaves the consulting room with a Diagnosis and a treatment.
Whether the treatment is appropriate or consistent with the guidelines of the
various medical societies, the majority of the concerns of the patient have not
been met.

This
is where the questions formulated by the late Medical Anthropologist (my
teacher and friend at Brunel University of London) Cecil Hellman come in handy.

Cecil Helman, an anthropologist,
suggested that a patient with a problem comes to the doctor seeking answers to
six questions:

1) What has
happened happened? This includes organising the symptoms and signs
into a recognisable pattern, and giving it a name or identity.

2) Why has it
happened? This explains the aetiology or cause of the condition.

3) Why has it
happened to me? This tries to relate the illness to aspects of the
patient, such as behaviour, diet, body-build, personality or heredity.

4) Why now? This
concern the timing of the illness and its mode of onset (sudden or slow)

5) What would
happen to me if nothing were done about it? This considers its likely
course, outcome, prognosis and dangers.

6) What are its
likely effects on other people (family, friends, employers, workmates) if
nothing were done about it? This includes loss of income or of
employment, or a strain on family relationships.

7) What should I do
about it -or to whom should I turn for further help? Strategies for
treating the condition, including self-medication, consultation with friends or
family, or going to see a doctor.

If
the Primary Care Providers kept these concerns in their heart, so much distrust
and second opinion seeking or seeking of other forms of treatment would become
unnecessary.

In
the context of taking care of patients with chronic conditions this is even
more necessary.

I
will give two examples: both of which are Signs or Symptoms and not actually
DISEASES, unless the Doctor makes it into a disease.

A
man around 30 years old, had been alcoholic for many years and now is seeking
and gaining a foothold in the normal world. While he had conquered his
Diabetes, Hypercholesterolemia with diet and advice from his counselors, he
remains anxious and at times it invading the tranquility of his life and has
bad effects on his self esteem.

He
had come to see me, a Specialist Physician, An anthropologist: I could delve
into the source of his anxiety from a social and cultural point of view and as
a Doctor, could prescribe some medications. While I spent time delving into the
current and immediate past life of his as well as his aspiration for the future,
“I would like to become a productive member of the community”, it would be a
crime if I sent him home just on his medications. I sought the assistance of a
Psychologist who agreed to see him and help him with his anxiety.

So
even though he had come for his anxiety, I would have been, even though I am a
specialist Endocrinologist, amiss not to refer him to a psychologist.

I
am very grateful for Dr Cecil Helman for the above wisdom and I always remember
what a Meskwakia elder said to me: Please make sure that the patient leaves
happier than when they came in.

The
second context I want to write about is a patient had been told she has
Pre-diabetes (in itself a constructed diagnosis) and given medications and
asked to come back in three months for further measurements of the parameters
that gave her the diagnosis of Pre-diabetes.

The
patient all those questions outlined by Dr Cecil Helman.

Why
me? Why no? Are there alternative forms of treatment? What will happen to me?
To my family?

We
are not discussing about the correctness of the diagnosis or the appropriateness
of the treatment but whether or not the expectations of the patient had been
met. The answer to the former is Yes and as regards to patient’s expectations
being met, NO.

She
comes to see us. I know her socially, as we know every one in this small village.

What
is that I can do to change or reverse the diagnosis? Is this possible? What are
the lifestyle adaptations I have to do? And my family? How would they be
affected by these changes.

My
role is to comfort her, to assure her, not to question the diagnosis or the
treatment, but explain the laboratory results in the global perspective of her
life, her marriage, her children and her family history of diabetes and her own
cultural history and the role of the disease in it.

I
needed the more than normal period of consultation to do this but she left the
room, happy, ready to follow a prescribed regimen of lifestyle changes which
would be good for her and husband and family and with no need for the
medications.

She
agreed to some basic nutritional changes but more importantly she made promises
to keep in touch with the Health Educator and the Nutritional Therapist on a
weekly basis and she would come when I am here next month. I was glad to hear
that she would like her husband to come when she comes to see the Medical
Nutritional Therapist.

In
view of the strong family history of Diabetes, she stands a chance of that
diagnosis in the future but now she should be given a chance to prove her
determination to put a stop to the changes in the blood test.

jeudi 20 juillet 2017

9 South Korean Nursing Students from Pusan, South Korea spent two days with us and many days with other members of the Health Department of the Winnebago Tribe of Nebraska. I was surprised to learn that Western Iowa Tech Community College has an active International Programme and these students were here for three weeks to immerse themselves in American culture as well as observe the clinical practices. I am glad they chose to come to the Indian Reservation, as they would be exposed to a more culturally oriented medical practice rather than visiting one of the established medical establishments in the city where they would be staying. There they would be just seeing a variation of the excellent medical and technological medical care they are already used to in South Korea.They were polite to a tee, very proper, very grateful, very soft spoken and eager to learn.It added a little spice to our daily routine as well. Of course Native American Culture and Korean Culture has many things in common.They delighted in simple pleasures of being in the midwest such as visiting a farm, going to the water amusement park, attending a parade.I am delighted to know of the presence of a International Exchange Programme in the city of the community college, an forgotten outpost of the American expansion in the 18th century.

I was happy to give them an introduction to the Native American Anthropology and also how we use the culture as a carrier of our health messages and treatment strategies .

After observing the various aspects of the health care at the Tribal Programmes at the Winnebago Hospital, the students uniformly said :1. at the winnebago clinics, patients are put first. Every one tries to help the patientthey said: before we came, we thought only about nursing and not about patient 2. They were amazed how closely the doctor and the nurses worked together at our clinic and that they were amazed at the higher status of nurses at the Indian Health care facility.

Many of the students fell ill during their stay, unable to adapt to the very hot midwestern summer weather with its added humidity, the allergens in the air.

Junior Nursing Class Curriculum.It was very interesting to listen to them about the harsh days of High School when their days started at 8 am and after the school finished at 4 pm, they went to remedial lessons and then attended Academies for extra tuition, which often went to 11 pm and sometimes until 1 am. The sleep was only 4 or 5 hours per night! That is how tought the competition is to secure a place in the Universities in South Korea. (the situation is very similar in Japan, China and Singapore)

dimanche 16 juillet 2017

I look forward to my Qatar airways flights. In May, I flew 10 long haul flights back to back with them and in the first two weeks of this month of July, I have been lucky enough to fly 4 long haul flights with them.I realize that the most important person for you on long haul flights (of course a pilot who is vigilant) is the Flight attendant who is who is "attending" your side.USA and Europe based airlines have been cutting down the number of Flight attendants on each flight, even if you are flying Business or First Class. Qatar Airways, recently selected as the Best Airline in the world, an outcome I wholeheartedly agree with, has a bevy of Flight Attendants. The number of flight attendants per flight alone does not guarantee service but generally on all the flights I have been on with Qatar Airways (with RARE exceptions, the service has been the best)Still, you remember some FAs more than the others, for other reasons than the best service they gave you. I can reel off the names of several: Christopher from Goa, Maria from Rumania, Barbara from Poland, Kedsarin from Thailand...But today, on my DOHA to JFK flight I was so lucky to have MIJIN from South Korea on my side: she was the perfect FA, polite but not servile or arrogant, acquiescent to your demands with grace but not with a chip on the shoulder, pro active to make sure your needs are anticipated and always there when needed but not intruding into the privacy which is fly most people fly upfront in Qatar Airways.

She has worked with QR for a number of years and she hails from South Korea. She has been on most of their long haul flights and delights in travel. Once a month she makes sure to go home.QR has strict policies regarding contacts between the workers in the company whether FAs or Supervisors at the various lounges having contacts with the passengers. Also my chance of encountering MIJIN on another trip is very small because of the large reach of QR to more than 150 cities around the world and the nearly 10 000 FAs in its fodder. So I wish her well in her chosen career and she made me realize what a good FA is all about and my trip went very well thanks to her.

The crew of the QR flight I came in would be resting now in NYC and tomorrow they would return home.

Needless to say I plan to fly QR againIn August I have a chance to fly them JFK to Doha, Doha to Casablanca, Casablanca to Kuala Lumpur via Doha and KL to Paris via Doha..

This is how hydrated my face was when I began my journey from DOHA to New York JFK.14 hours later, despite having a total of 8 hours sleep, the face demonstrates the dehydration of a long flight .

I wish I was in Siem Reap or KL, where I could easily arrange for a relaxing facial massage after a long flight..Strangely enough the Uber Driver who took me to my sisters home was a qualified Physiotherapist and Massaged Therapist and we talked about the importance of getting body massages on a regular basis.On this 21 day round the world trip, I was able to have daily massages for four days in Siem Reap and a lovely facial by Anna at Guinot in KLCC in KL.After seeing the above photograph, I have decided to abstain from alcohol for a two week period and see the effects of it on my skin..

vendredi 14 juillet 2017

I
am at Riad Hamdani, a bed and breakfast lodging place, Moroccan style, very
comfortable and inspiring near the Mohammed V International Airport in
Casablanca.

In
the morning, facing the garden and the swimming pool I sat down for my breakfast,
which I had been looking forward to, I would like a Maghrebi breakfast please! Soon
enough ingredients began arriving one by one, apricot marmalade, peanut sauce,
citrus marmalade, cheese, yogurt, watermelon, thick crusted Moroccan bread, a
tasty omelette but the centre piece was indeed: MSEMEN, a flaky pastry like
pancake with layers separated, filled with butter and crispy and very tasty.

It
is difficult to make this, the owner, who with her Moroccan husband owns and
runs this place, said to me. She is of Belgian origin from a place closer to
the German border. It takes very long time, and it has to be spun and suddenly
it occurred to me, she is describing something I commonly see in the streets of
Cochin, Kerala, India and also in my favourite eating-places in Indian parts of
Kuala Lumpur.

Mesamen or musamen (Arabic: مسمن), also called malawi, malawah or murtabak, is a
rich traditional, pancake-like bread of the Maghreb, most
common to Morocco, Algeria and Tunisia. These pancake-like breads are usually
an accompaniment to a cup of aromatic morning mint tea or coffee. Msemen can be
stuffed with vegetables or meat fillings.

Yes, the humble Paratta or parotha of Kerala is a cousin to
this bread, which can be eaten at breakfast or as a snack or filled with meat
or potatoes.

I especially felt good about the MSEMEN today, thinking of
the young Muslim spinning his murtabak like a dervish in the café that I visit
now and then in Fort Cochin, Kerala.

Also the Maulana Indian Resto in Seri Kembangan, where my
best friend in asia lives, a good place for Parotta or Murtabak and some curry.

I have had Parottas in

Malaysia

Singapore

Kerala India

Seria, Brunei, also Kuala Belait

Doha Qatar

Its cousin in Casablanca

And look forward to learn more about its migration from the
Middle East to India as well as Maghreb.

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Welcome to Cuba, Welcome to My World and Yours as well

Ever since I was a child, I have lived in two countries at a time and the countries changed: Brunei, Australia, Sweden, USA, England, Jamaica, various places in the USA..Now Cuba and USA with a definite commitment to the North American Indians (Los Indios)..

For a period, 2001-2014, there were numerous visits to Vietnam, Cambodia, Malaysia, Indonesia and Myanmar.Hope you enjoy reading my emotional outpourings, written on the road.. from a lover of Cuban Mind and Affections inside the island and the innocence of the Indigenous peoples..

We live with great expectation that the new rapprochement with the Govt of President Obama, will bring more changes, intellectual and cross cultural contacts and a broadening of the minds on both sides of the Straits.

I highly recommend that you come to visit CUBA now..

Qui êtes-vous ?

Ever since being a Medical Student and Trainee Doctor in Melbourne, London and Miami, I have been involved in Interantional Medicine . Currently I am associated with the excellent Peer to Peer Network for Diabetes care in Cambodia, Mo Po Tsyo, www.mopotsyo.org.
Also with the help of my good friends in Bogor, Indonesia we hope to do something similar but in a much smaller scale.
It is easy to tell you what I am: an Endocrinologist and a Medical Anthropologist, engaged in both fields.
Cuba, Miami and American Indians are the worlds that usually I rotate around. in the occident and Cambodia and Indonesia in the orient.